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Detection of Crimean-Congo Haemorrhagic Fever cases in a severe undifferentiated febrile illness outbreak in the Federal Republic of Sudan: A retrospective epidemiological and diagnostic cohort study

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Smith, Darci, Bower, Hilary, El Karsany, Mubarak, Alzain, Mazza, Gannon, Benedict, Mohamed, Rehab, Mahmoud, Iman, Eldegail, Mawahib, Taha, Rihab, Osman, Abdalla, Mohamednour, Salim, Semper, Amanda, Atkinson, Barry, Carter, Daniel, Dowall, Stuart, Furneaux, Jenna, Graham, Victoria, Mellors, Jack, Osborne, Jane, Pullan, Steven T., Slack, Gillian S., Brooks, Tim, Hewson, Roger, Beeching, Nicholas ORCID: https://orcid.org/0000-0002-7019-8791, Whitworth, Jimmy, Bausch, Daniel G. and Fletcher, Tom (2019) 'Detection of Crimean-Congo Haemorrhagic Fever cases in a severe undifferentiated febrile illness outbreak in the Federal Republic of Sudan: A retrospective epidemiological and diagnostic cohort study'. PLoS Neglected Tropical Diseases, Vol 13, Issue 7, e0007571.

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Abstract

Background
Undifferentiated febrile illness (UFI) is one of the most common reasons for people seeking healthcare in low-income countries. While illness and death due to specific infections such as malaria are often well-quantified, others are frequently uncounted and their impact underappreciated. A number of high consequence infectious diseases, including Ebola virus, are endemic or epidemic in the Federal Republic of Sudan which has experienced at least 12 UFI outbreaks, frequently associated with haemorrhage and high case fatality rates (CFR), since 2012. One of these occurred in Darfur in 2015/2016 with 594 cases and 108 deaths (CFR 18.2%). The aetiology of these outbreaks remains unknown.
Methodology/Principal findings
We report a retrospective cohort study of the 2015/2016 Darfur outbreak, using a subset of 65 of 263 outbreak samples received by the National Public Health Laboratory which met selection criteria of sufficient sample volume and epidemiological data. Clinical features included fever (95.8%), bleeding (95.7%), headache (51.6%) and arthralgia (42.2%). No epidemiological patterns indicative of person-to-person transmission or health-worker cases were reported. Samples were tested at the Public Health England Rare and Imported Pathogens Laboratory using a bespoke panel of likely pathogens including haemorrhagic fever viruses, arboviruses and Rickettsia, Leptospira and Borrelia spp. Seven (11%) were positive for Crimean-Congo haemorrhagic fever virus (CCHFV) by real-time reverse transcription PCR. The remaining samples tested negative on all assays.
Conclusions/Significance
CCHFV is an important cause of fever and haemorrhage in Darfur, but not the sole major source of UFI outbreaks in Sudan. Prospective studies are needed to explore other aetiologies, including novel pathogens. The presence of CCHFV has critical infection, prevention and control as well as clinical implications for future response. Our study reinforces the need to boost surveillance, lab and investigative capacity to underpin effective response, and for local and international health security.

Item Type: Article
Subjects: WA Public Health > WA 105 Epidemiology
WA Public Health > Health Problems of Special Population Groups > WA 395 Health in developing countries
WC Communicable Diseases > Virus Diseases > General Virus Diseases > WC 500 Virus diseases (General or not elsewhere classified)
WC Communicable Diseases > Virus Diseases > Viral Hemorrhagic Fevers. Other Virus Diseases > WC 534 Viral hemorrhagic fevers
Faculty: Department: Clinical Sciences & International Health > Clinical Sciences Department
Clinical Sciences & International Health > International Public Health Department
Digital Object Identifer (DOI): https://doi.org/10.1371/journal.pntd.0007571
Depositing User: Stacy Murtagh
Date Deposited: 23 Sep 2019 12:30
Last Modified: 23 Sep 2019 12:30
URI: https://archive.lstmed.ac.uk/id/eprint/12503

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